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HomeMy WebLinkAbout1008A (5) WORKERS-�oMPENSAT�oNOE��,RAT�oN � �. APPLICATION FOR PERMIT j� I hereby aff'nm that I have a certi(icate of consent to self ' - indvre,ror a certifimte of Workeri Compensation i�:��a��a, .���� . � HEATING -�VENTILATING - AIR CONDIiIONiNG � LS or a cerfified copy�hereof(Sec.3800,La6.C.) - - CE•8I8(REV:lOiBlj � - - � � � �-� � . P❑ol'�cyNo. F 21926Company Fairmont Ins. , � � � � Cenifted copy�s hereby turnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY O Cerrified copy is(iled wirh the county building Inspec- FOR APPLICANT TO FILL IN eunowc 1�1� ti0n flepOfimenl. , (PRIM OR TYPE ONIY� ADDRE55 244 E. Gold oint Pl LO'fi 17 Date 5124/87 APPlicani Rancho Air, Inc. - � _ iocnun � � NO. TYGE OF APPLIANCF OR EOUIPMENT FEE D'amond Bar CA Tract 2 CERTIFICATE OF EXEMPTION FROM WORKERS' NEnREST � � COMPENSATION INSURANCE � CRO55 ST. .(Thb saetion noed not M compla}ed if}ha work involved by ABSORPTION UNIT,BTU DISiRIU NO. PRpGE55E0 9Y th�permtf I�for on�hondr�d dollan(SIOD)or la�s.) I cerlify fhat in ihe per/ormonce o4 Ihe work(or which 7his , AIR HANDLING UNIT,CFM /O � j, �Y �permif is issoed,I shall noi employ ony person in any manner BOILER,BTU � so os to become subject to the Workers'COTPBnSOtiOl1 LOWS. AVGROVALS ' DAiE INS�ECiOR'$SIGNAfURE f� 4pplicanf 1' COMPRESSOR,BTU 27+SOO ZO O ROUGM 30�{� � . ! .ICE TO APPLICANT: If, ai�er making this Cerlificale of VENTILATION SYSTEM FiNA� 1 Exemption, you should become subjett lo �he Woike�s' Compensafion provisions of the Labor Code,yov must(orth- � fVAPORATIVE COOiER VALIDATION with comply with s�ch provisions or ihis permit shall be � deemed revoked. ' � ' � � fURNACE: FAU�S7LGRAYLIY��� lo O � LICENSED CONTRACTORS DECLARATION �- fLOOR BTU OLS � � I hereby affirm Iha�I om licensed under pravisions of Chopter 9 SUSPENDED UNIT_ �� � '(commencing with Section 7000)of Drvision 3 of�he Business NEATER: WA�� ` and Professions Code,ond my license is in full force ond effecL � �-�� - - - � O O.8 A } 8 Re isters C 1.75 l�+ 0 a ttcense Number 380543 � �i;�,cia,s �.'-2� _ , . . �"'� � ��8 {Oj Comractor RanCho Air,InC.po�e 8/15�87 _ I +a 4 4:5 0 � o[i450� ❑ �I am exempt under Sec. , �" w Plan check fee N B.&P.C.for this reason PERMIi ISSUING FEE S C�[O`S 6 . Z Dote: TOTAL FEE �i�+ SO Signature , � OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby pffirm thal I am exempl from the CoNraclor's License � - � �l w for ihe 4ollowing reason(Settion 7031.5, Business ond NAME � C� `essions Code): � � �1 I, os owner of Ihe propeny, or my employees with /+�RESS � � � � wages as lheir sole tompensation,will do Ihe work and �ITY � � iEl.NO. � � ' � fhe shoUura is not intended or offered far sole(Secfion � , - 70a4,Business ond Professions Cade). � � �� � � � � - OWNER Grou - ❑ I,os owner of the property,am exclusively coniratling wilh licensed[oniractors to construc�fhe projeU(Sec- M�`�� � -� � � " � - tion 7044,�Business ond Professions Code). ADORESS Q �i Parkview Drive N201 . � CONSTRUCTION IENDING AGENCY � ��7V V�178 � TEL.NO. 67— �1 1 hereby affirm thol�here is o conslruction lending agency for , � � the performance of Ihe work for whlch this permit is issued � COMRACTOR Rancho�Air IriC. (Sec.3097.Civ.C.�. _ . . . . _. .. - . . . . ._. . . . ADDRESS 1`2 2 W. tiYl St. ._ . . .. . . . . . ._ . lendePs Nome . ' aTr. U land tei.Na 81-4801_ _ . . lender's Address � Y PP � LICENSENO. O 11 -- QA55.. .C—'�O .. . ._. . 1 terfif that I hove read lhis a licol'on and sta�e Ihot ihe� . . . . .. ... . .. .. ... _ ... above information is mrrecf.I agree to mmply with oll County ordinonces ond Slafe laws relaling lo building construction, . . . . _ , , _ ond hereby authorize represenlotives of ihis Counry fo enter , - - - � � � " " � � . �n�he abo1ve�-mention�ed/p�r/�op�erty for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � ��/ �a�(.c16s6 �3 �7�Q— _. . _ Signarura of Applicanl or A9eni � Dole .- � . . . . . . . _ . _ .,. . . _ ._ . _ .. i •J,.I...'�y. :._. . , , .; . .. . . .... .. ..- .. . ` . ._ , , . .. • •IP7S*ECTOR'S NOTES OWNE�i-SUILOER DECLARATION � � - 1 hereby affirm lhat I am ezempt from ihe Controdor's ""' � �'�� "�� �" - License Law for�the following �eason (Sac/ion 70JI.5, ".._'. .'."'_.._""_ ._._..._.__. ._....-_.._:_-_ .__. . ...._.__ .._........ ... ..... .__.. ._ .._........._'._ QuslnessandProfessionsCode):AnyNfyorcovnfywhlch � � � - . � -, � - , . � � requires'o permR ro construcf,cheq lmprove,demolish, � �:i�- -— . . .=..'� .. �-��-`-- - '-'- - �- ----�-' ... . � � � or repair qny siructure,pr(or�fo lis Bsuonce, also ie. . . `.� ' - . . �� �� . . _ qotres Ihe applican�for such permii fo file a slgnod srofe- � --- '"-"-" �� �� � � " - �" ' '� � ' ' � � � menf Ihaf he Is Ilcensedpursuanf fo fhe provisions o1 fRe � �, Contrador'i license Low(Chaptvr 9(commondng with ' � :._..._.__..,.,_......._.... ."..,,._..._ _...... ..... ...'... . . � � , � ' � .. SeUlon 7C00)ol Oivlzion 3 of fhe 6uslness and Prales- I � , � . � sions CodeJ orlhaf he is exempl therelrom and fhe basis I '. i., � _.. . _ '� � - for Ihe�.olleged exemplion. Any violafion ol Sec�ion ; „ L .. .__. . .. .-.'--..__�. '�_._ . . � - ..- -._. 70J1.5 hy any applicanlJor a�permit subjects fhe applf� j . .. .. .. ._ . _ ' .. __ ._._. .. . . .. . cant to a.clvll penolry_of,nof more,.fhan flve hundred �i.. - �-—-----_ __.--. �_� _. �- - - - - -- • . . doflors(5500).: . . . . �� . - -� '�- ,-. - - � ' ' �' � � � ' ❑I,os owncr of tho o crr 'll do Ihe wor�ond � - _� � .�. ` ��'��... .__ .__ . �. . ,. '� -.. - , � tse strudure is nol Pr P Y W1 , � � � , �. � _. ( iNended or offered f or sale..,' - �-- - - - � ec.7044,Buslrtess ond Profe:slons Code: The C�.,.`ac- - � � . _ , . ;ror's licensc Low does not opply to an owner o(property i.'... .:.'..,, . � -- . .._ , . . , . . � . __._,.. __. _ __. _ _ �,�who bullds.cr.tmproves Ihereon, and.who does wch . . , __ . .. . work himsefl provided fhaf such lmprovementz ore no7 ' � -.- '�--'��- �-- '� _ _� � ' infendedorbRaredlorsafe..if,however.ibebulldingor i..___. . . - �: � . � . .. . _ � . , improvement ts sold wilhfn one year of compfeNon,�!he ,� . �. . .-_ ._'. - � � --- ' . _. . ' . ownervbWlderwlll hovc�hc burden of proving thot he did � _ � . • � nol build or(mprovc for Ihe porpose of salo.) � . . � � � , ' � �� - ❑I,as owner af�the propery,am exclusively com , . , ,. , . I � - �tracling wilh licensed tontrecters to construct ihe�projed � ,� -- �- �� --- ----� �(Sec.7044)Boslnass and Pro(essions Code:The Comroo- _ ' -- �-�o�'s Liccnse Law does nof apply to en owner�ol properfy ' " ' - �--�-- � � -- --- - � -� ` who butlds or Improves.fhcreon,ond who tonfracts/or . , . • � � � � ��'� • such projects witF a mniroctor(s)licensed pursuani�o _. . .:�_..�.�..�.-. . �..�.. -. ,... . - .. .. --.. .ihe Con7athori license!aw). ' . � -� ' � �� I�am exempt under Sec �� � . .. ¢ ., � . � . , . ,. , . .. _ . . . .. � B&P.C.for this reason _ __ _. _. .. .__ __-�-- - ------__ ..--- �. . , ' . . Date � . . � _. ' ; Owner , - --. _ . __._. _._.. . .---- __. _ .. � ,.,. INSPECTOft'S N07E5 _ - ,. _ . � _ � � . , _ __ _ _ . „ � __ . __. _ — �lc���1{�� ��� � q 1�� (� �L,� � •;•.:L._�.�'._s,:, .Lr....�b.N��